Provider First Line Business Practice Location Address:
5738 US 25/70 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28753-6364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-649-9276
Provider Business Practice Location Address Fax Number:
828-649-0556
Provider Enumeration Date:
12/04/2007